Oral progestin (pills or tablets; used along with an estrogen-only preparation)

Generic Name

Brand Name

medroxyprogesterone

Provera

micronized progesterone

Prometrium

norethindrone

Micronor, Nor-QD

norethindrone acetate

Aygestin

Progestin intrauterine device (IUD; used along with an estrogen-only preparation)

Generic Name

Brand Name

levonorgestrel

Mirena

Estrogen-progestin hormone therapy, or HT, is recommended
for all women with a uterus who choose to take estrogen. Using estrogen without
progestin greatly increases your risk of
endometrial cancer. Taking progestin with estrogen
eliminates this increased risk.1

How It Works

HT increases the estrogen and progestin
levels in your body. There are several ways to take HT,
including continuous and cyclic along with higher-dose and low-dose.

Combining progestin with estrogen:

Protects against endometrial cancer (which can
develop with estrogen-only therapy).

Is not needed for women who
have no uterus.

May trigger monthly withdrawal bleeding when
progestin is used periodically (such as in cyclic HT).

Why It Is Used

The estrogen in hormone therapy is
used by some postmenopausal women to increase estrogen levels. This helps
prevent
osteoporosis and perimenopausal symptoms, such as hot
flashes and sleep problems.

But HT slightly increases risks of
some serious health problems. In a small number of women, HT
may increase the risk of blood clots, stroke,
heart disease, breast cancer, ovarian cancer, or dementia. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.2

Because of the risks from HT, many experts recommend that HT be used for:

Short-term treatment of menopause symptoms. HT effectively relieves menopause symptoms for most women. Women who decide that HT benefits outweigh their risks are advised to use the lowest effective dose for as short a time as possible.2 For most women, menopause symptoms naturally improve within a few years' time, making long-term symptom treatment unnecessary.

Osteoporosis prevention and treatment, in select cases. Most experts recommend that long-term HT only be considered for women with a high osteoporosis risk. In this case, estrogen's bone-protecting benefit may outweigh the risks from taking HT. Women are now encouraged to consider all possible osteoporosis treatments and to compare their risks and benefits.

Some of these side effects, such as
headaches, nausea, fluid retention, weight gain, and breast tenderness, may go
away after a few weeks of use.

Progestin side effects

The side effects of
progestin often cause women to stop using hormone therapy (HT).
Adjusting the progestin dose, changing the dosing schedule, or changing the
type of progestin may reduce side effects. The progestin
intrauterine device (IUD) reduces or eliminates side
effects that are common with oral progestin.1

Progestin side effects include:

Mood changes, such as anxiety, irritability,
or depression.

Headache.

Breast pain or
tenderness.

Abdominal (belly) pain or bloating
(distention).

Dizziness or
drowsiness.

Diarrhea.

Vaginal discharge.

Cyclic progestin (taken 10 to 14
days a month) is more likely to cause:

See Drug Reference for a
full list of side effects. (Drug Reference is not available in all
systems.)

What To Think About

Risks from hormone therapy

Risk varies based on when you start HT in menopause and how long you take it. Hormone
therapy (HT) may increase the risk of health problems in a small number of women. Using HT may increase your risk of:

Stroke.

Blood clots.

Heart disease.

Breast cancer.

Uterine (endometrial) cancer.

Gallstones.

Ovarian cancer.

Dementia.

Urinary incontinence.

If you have been taking HT, talk with your doctor about your reasons for
taking it. Are you taking it to help with perimenopausal symptoms or for
long-term health reasons? Consider changing to another treatment, depending on
the problem you are using HT to treat. If HT seems like the best choice for
you, plan to use the lowest possible effective dose.

If you are
unable to tolerate the side effects of progestin in hormone therapy
and you have not had a
hysterectomy, try nonhormonal treatment options.

When given with a skin patch, estrogen-progestin
enters the bloodstream directly, without passing through the liver. The
estrogen and progestin in pills must be processed by the liver before entering
the bloodstream. This is why women with liver or gallbladder disease can
usually use a patch form of HT.

Direct sunlight or
high heat can increase, then decrease, the amount of hormone released from a
patch. This can give you a big dose at the time and leave less hormone for the
patch to release later in the week. Avoid direct
sunlight on the hormone patch. Also avoid using a tanning bed, heating pad,
electric blanket, hot tub, or sauna while you are using a hormone patch.

References

Citations

North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.

North American Menopause Society (2010). Estrogen and
progestogen use in postmenopausal women: 2010 position statement of the
North American Menopause Society. Menopause, 17(2):
242–255. Also available online: http://www.menopause.org/PSht10.pdf.

North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.

North American Menopause Society (2010). Estrogen and
progestogen use in postmenopausal women: 2010 position statement of the
North American Menopause Society. Menopause, 17(2):
242–255. Also available online: http://www.menopause.org/PSht10.pdf.

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